Classifying Leptomeningeal Disease: An Essential Element in Managing Advanced Metastatic Disease in the Central Nervous System

Kirkpatrick, John P.

doi:10.1016/j.ijrobp.2019.12.016

Cited by 6 publications

(7 citation statements)

References 11 publications

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“…The clinical significance of LMD risk is difficult to ascertain across studies, given that LMD subtype (ie, nodular versus diffuse) is often not reported despite its prognostic and therapeutic implications. 34 Significant associations between LMD, surgical resection, and primary breast tumor origin were consistent with prior reports. 35 , 36 In contrast to a recent 5-fraction HF-SRS series, this study revealed no association between LMD and number of BMs.…”

Section: Discussionsupporting

confidence: 88%

Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery

Carpenter

Fairchild²,

Adamson³

et al. 2023

Advances in Radiation Oncology

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Section: Discussionsupporting

confidence: 88%

Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery

Carpenter

Fairchild²,

Adamson³

et al. 2023

Advances in Radiation Oncology

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“…However, the treated and untreated patients are difficult to compare and selection bias may play an important role [ 56 , 59 , 60 ]. Diffuse leptomeningeal spread should be differentiated from nodular involvement, which may occur more frequently after resection of brain metastases treated with postoperative SRS/SRT compared to WBRT and is more common in patients with BCBM compared to other entities [ 61 , 62 ]. It remains uncertain whether the two types of leptomeningeal carcinomatosis require distinct treatment approaches, and whether the recently proposed new approach of preoperative stereotactic radiosurgery/stereotactic radiation therapy can effectively prevent the occurrence of nodular leptomeningeal carcinomatosis after surgery.…”

Section: Resultsmentioning

confidence: 99%

DEGRO guideline for personalized radiotherapy of brain metastases and leptomeningeal carcinomatosis in patients with breast cancer

Borm,

Behzadi,

Hörner-Rieber

et al. 2024

Strahlenther Onkol

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Purpose The aim of this review was to evaluate the existing evidence for radiotherapy for brain metastases in breast cancer patients and provide recommendations for the use of radiotherapy for brain metastases and leptomeningeal carcinomatosis. Materials and methods For the current review, a PubMed search was conducted including articles from 01/1985 to 05/2023. The search was performed using the following terms: (brain metastases OR leptomeningeal carcinomatosis) AND (breast cancer OR breast) AND (radiotherapy OR ablative radiotherapy OR radiosurgery OR stereotactic OR radiation). Conclusion and recommendations Despite the fact that the biological subtype of breast cancer influences both the occurrence and relapse patterns of breast cancer brain metastases (BCBM), for most scenarios, no specific recommendations regarding radiotherapy can be made based on the existing evidence. For a limited number of BCBM (1–4), stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (SRT) is generally recommended irrespective of molecular subtype and concurrent/planned systemic therapy. In patients with 5–10 oligo-brain metastases, these techniques can also be conditionally recommended. For multiple, especially symptomatic BCBM, whole-brain radiotherapy (WBRT), if possible with hippocampal sparing, is recommended. In cases of multiple asymptomatic BCBM (≥ 5), if SRS/SRT is not feasible or in disseminated brain metastases (> 10), postponing WBRT with early reassessment and reevaluation of local treatment options (8–12 weeks) may be discussed if a HER2/Neu-targeting systemic therapy with significant response rates in the central nervous system (CNS) is being used. In symptomatic leptomeningeal carcinomatosis, local radiotherapy (WBRT or local spinal irradiation) should be performed in addition to systemic therapy. In patients with disseminated leptomeningeal carcinomatosis in good clinical condition and with only limited or stable extra-CNS disease, craniospinal irradiation (CSI) may be considered. Data regarding the toxicity of combining systemic therapies with cranial and spinal radiotherapy are sparse. Therefore, no clear recommendations can be given, and each case should be discussed individually in an interdisciplinary setting.

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“…Nevertheless, MRI sensitivity can greatly vary depending on the experience of the neuroradiologist and the use of appropriate sequences (contrast-enhanced T2 FLAIR, three-dimensional T1 black-blood fast spin-echo imaging) ( 21 ). Pathologic linear or nodular meningeal contrast-enhancements are classically visualized on gadolinium-injected T1-WI and localized on the cortical surface, gyri and sulci, cerebellar folia, the ventral surface of the brainstem and the spinal cord ( 22 – 24 ). Cranial nerves and spinal roots can also be pathologically enhanced.…”

Section: Discussionmentioning

confidence: 99%

Long-term response to sequential anti-HER2 therapies including trastuzumab-deruxtecan in a patient with HER2-positive metastatic breast cancer with leptomeningeal metastases: a case report and review of the literature

de Bernardi,

Bachelot,

Larrouquère

2024

Front. Oncol.

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The incidence of leptomeningeal metastases (LM) is increasing among breast cancer patients, but their prognosis remains dismal. Many therapeutic options are now available to treat HER2-positive (HER2+) metastatic breast cancer (MBC) involving the central nervous system (CNS). This case report illustrates a long-lasting response of more than 2 years in a patient with HER2+ MBC with LM after sequential administration of systemic and intrathecal (IT) anti-HER2 therapies and highlights that an appropriate treatment of HER2+ LM can result in durable survival.

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Classifying Leptomeningeal Disease: An Essential Element in Managing Advanced Metastatic Disease in the Central Nervous System

Cited by 6 publications

References 11 publications

Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery

Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery

DEGRO guideline for personalized radiotherapy of brain metastases and leptomeningeal carcinomatosis in patients with breast cancer

Long-term response to sequential anti-HER2 therapies including trastuzumab-deruxtecan in a patient with HER2-positive metastatic breast cancer with leptomeningeal metastases: a case report and review of the literature

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